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BACKGROUND AND AIM: Ongoing climate variability and change is altering the timing of spring onset, a critical event that signifies the start of tree pollen season in North America. There is a pauci...

A breast cancer diagnosis is a critical event with a potentially traumatic nature. In recent years there has been an increase of this illness in women aged under-fifty, a group of particular scientific interest. In this article the authors review the recent scientific literature on psychological impact of breast cancer experiences in under-50 women. Our results highlight three trajectories: clinical psychological risks; feminine-specific concerns; resources between individual and relational aspects. This overview illustrates the complexity of the effects of breast cancer in under-50women allowing to think about theoretical and psychosocial models to provide support for under-50 women during the illness experience.

Uniparentally-inherited markers on mitochondrial DNA (mtDNA) and the non-recombining regions of the Y chromosome (NRY), have been used for the past 30 years to investigate the history of humans from a maternal and paternal perspective. Researchers have preferred mtDNA due to its abundance in the cells, and comparatively high substitution rate. Conversely, the NRY is less susceptible to back mutations and saturation, and is potentially more informative than mtDNA owing to its longer sequence length. However, due to comparatively poor NRY coverage via shotgun sequencing, and the relatively low and biased representation of Y-chromosome variants on capture assays such as the 1240 k, ancient DNA studies often fail to utilize the unique perspective that the NRY can yield. Here we introduce a new DNA enrichment assay, coined YMCA (Y-mappable capture assay), that targets the "mappable" regions of the NRY. We show that compared to low-coverage shotgun sequencing and 1240 k capture, YMCA significantly improves the mean coverage and number of sites covered on the NRY, increasing the number of Y-haplogroup informative SNPs, and allowing for the identification of previously undiscovered variants. To illustrate the power of YMCA, we show that the analysis of ancient Y-chromosome lineages can help to resolve Y-chromosomal haplogroups. As a case study, we focus on H2, a haplogroup associated with a critical event in European human history: the Neolithic transition. By disentangling the evolutionary history of this haplogroup, we further elucidate the two separate paths by which early farmers expanded from Anatolia and the Near East to western Europe., Open Access funding enabled and organized by Projekt DEAL. This study was funded by the Max Planck Society, the French (ANR) and German (DFG) Research Foundations under the INTERACT project (ANR-17-FRAL-0010, DFG-HA-5407/4-1, 2018-2021) to M.R. and W.H., the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program under Grant agreement no. 771234-PALEoRIDER to W.H., the award Praemium Academiae of the Czech Academy of Sciences to M.E. and the project RVO 67985912 of the Institute of Archaeology of the Czech Academy of Sciences, Prague to M.S.

The efficient utilization of available resources while simultaneously achieving control objectives is a primary motivation in the event-triggered control paradigm. In many modern control applications, one such objective is enforcing the safety of a system. The goal of this paper is to carry out this vision by combining event-triggered and safety-critical control design. We discuss how a direct transcription, in the context of safety, of event-triggered methods for stabilization may result in designs that are not implementable on real hardware due to the lack of a minimum interevent time. We provide a counterexample showing this phenomena and, building on the insight gained, propose an event-triggered control approach via Input to State Safe Barrier Functions that achieves safety while ensuring that interevent times are uniformly lower bounded. We illustrate our results in simulation., Comment: 6 pages, 2 figures, submitted to L-CSS + CDC 2020

Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n=5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO2

New Experimental Approach to Retinal Degeneration Loss of retinal photoreceptor cells is a critical event in loss of vision. A new, albeit tentative, strategy to rectify the loss of photoreceptor c...

Dysfunctional beliefs are the central element in cognitive-behavioral conceptualizations of obsessive–compulsive disorder (OCD). The purpose of this study was to further elucidate the etiological role of preexisting dysfunctional beliefs in the occurrence of unwanted intrusive thoughts and neutralizing behaviors after a critical event by examining their predictive value and specificity in a prospective study with undergraduate students. The dysfunctional belief domains importance/control of thoughts (ICT), responsibility/threat (RT), and perfectionism/certainty (PC) were assessed at baseline 8 weeks prior to the critical event “exam situation” in N = 169 students. Exam-related unwanted intrusive thoughts and neutralizing behaviors, anxiety, and depression were assessed during the week immediately before the exam. Complete data for both baseline and follow-up were available for 79 participants (46%). After controlling for baseline obsessive–compulsive symptoms, anxiety, and depression, ICT but not RT or PC prospectively predicted exam-related intrusive thoughts and neutralizing behaviors, ICT also prospectively predicted depressive symptoms but not anxiety, and RT and PC both prospectively predicted anxiety but not depressive symptoms. Findings are partially consistent with cognitive models of OCD. They support the idea that ICT is a cognitive vulnerability factor for unwanted intrusive thoughts and neutralizing behaviors during a stressful event. Its predictive power was small and not specific to unwanted intrusive thoughts and neutralizing behaviors.

Embryo implantation is one of the pivotal steps during mammalian pregnancy, since the quality of embryo implantation determines the outcome of ongoing pregnancy and fetal development. A large number of factors, including transcription factors, signalling transduction components, and lipids, have been shown to be indispensable for embryo implantation. Increasing evidence also suggests the important roles of epigenetic factors in this critical event. This review focuses on recent findings about the involvement of epigenetic regulators during embryo implantation.

The conversion of a protein from its native conformation to the pathogenic form is a critical event in the pathogenesis of several neurodegenerative disorders such as Alzheimer’s (AD), Parkinson’s, and Huntington’s diseases, along with type II diabetic mellitus. Although there are several reports on the mechanism of protein aggregation, the actual conformation playing a part in the pathogenicity is yet unclear. Accordingly, the present study summarizes the early pathogenic conformation resulting in several protein aggregations. It is well-documented that a pre-molten globule (MG) structure appears at the early stages of some proteins. Pre-MG is one of the intermediate structures, which is formed during some protein unfolding processes. In addition, it is shown that the pre-molten structure is more flexible than the mature MG one and thus, protein easily rearranges to form amyloid fibrils in this conformation. Therefore, protein aggregation is halted by preventing the pre-MG structure. The strategy of protein aggregation prevention has profound implications in fighting the devastating disorder.

Fire is the foremost critical event for road tunnels' safety. Therefore, the European Commission introduced the Directive 2004/54/EC for enhancing tunnels' safety since they constitute a key element of the Trans-European Road Network. The Directive has established a common ground for tunnels' safety evaluation providing certain minimum requirements while introducing officially the use of risk assessment. Despite the significant progress, this paper illustrates that further efforts are needed. Through a comparative review of the risk assessment methods, questions about the level of harmonisation of the framework are raised. Moreover, considerable problems are highlighted, like the incorporation of the new trends emerging from the literature or the deficiencies on addressing significant issues of the analysis, such as the risk acceptance criteria and the behaviour of trapped-users. These problems can affect the risk assessment process causing both significant discrepancies and deficiencies at the estimated level of tunnels' safety. Uncovering, thus, the deficiencies and limitations of the methods, this paper contributes to i) the discourse for initiating relevant studies to enhance tunnels’ fire safety in Europe and worldwide, and ii) the harmonisation of risk assessment methods. Keywords: Road tunnel, Safety, Fire, Risk assessment

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. The authors’ objective was to understand barriers to debriefing, characterize quantifiable patterns and qualitative themes, and learn potential solutions through a mixed-methods study of actual critical events experienced by anesthesia personnel. Methods At a large academic medical center, anesthesiology residents and a small number of attending anesthesiologists were audited and/or interviewed for the occurrence and patterns of debriefing after critical events during their recent shift, including operating room crises and disruptive behavior. Patterns of the events, including event locations and event types, were quantified. A comparison was done of the proportion of cases debriefed based on whether the event contained a critical communication breakdown. Qualitative analysis, using an abductive approach, was performed on the interviews to add insight to quantitative findings. Results During a 1-yr period, 89 critical events were identified. The overall debriefing rate was 49% (44 of 89). Nearly half of events occurred outside the operating room. Events included crisis events (e.g., cardiac arrest, difficult airway requiring an urgent surgical airway), disruptive behavior, and critical communication breakdowns. Events containing critical communication breakdowns were strongly associated with not being debriefed (64.4% [29 of 45] not debriefed in events with a communication breakdown vs. 36.4% [16 of 44] not debriefed in cases without a communication breakdown; P = 0.008). Interview responses qualitatively demonstrated that lapses in communication were associated with enduring confusion that could inhibit or shape the content of discussions between involved providers. Conclusions Despite the value of proximal debriefing to reducing provider burnout and improving wellness and learning, failure to debrief after critical events can be common among anesthesia trainees and perhaps anesthesia teams. Modifiable interpersonal factors, such as communication breakdowns, were associated with the failure to debrief.

Ferroptosis is a recently recognized cell death modality that is morphologically, biochemically and genetically distinct from other forms of cell death and that has emerged to play an important role in cancer biology. Recent discoveries have highlighted the metabolic plasticity of cancer cells and have provided intriguing insights into how metabolic rewiring is a critical event for the persistence, dedifferentiation and expansion of cancer cells. In some cases, this metabolic reprogramming has been linked to an acquired sensitivity to ferroptosis, thus opening up new opportunities to treat therapy-insensitive tumours. However, it is not yet clear what metabolic determinants are critical for therapeutic resistance and evasion of immune surveillance. Therefore, a better understanding of the processes that regulate ferroptosis sensitivity should ultimately aid in the discovery of novel therapeutic strategies to improve cancer treatment. In this Perspectives article, we provide an overview of the known mechanisms that regulate sensitivity to ferroptosis in cancer cells and how the modulation of metabolic pathways controlling ferroptosis might reshape the tumour niche, leading to an immunosuppressive microenvironment that promotes tumour growth and progression.

A veterinary anesthesia simulated environment (VASE) with clinical scenarios has been integrated into the pre-clinical curriculum at Midwestern University College of Veterinary Medicine to simulate anesthesia of a live patient within a surgical suite. Although this modality was shown to significantly improve veterinary students’ perceived preparedness to perform anesthesia on live patients, whether this would improve anesthesia competency in the actual clinical environment, described as operational performance, remained unclear. Our goal was to examine the relationship between anesthesia simulation training and student anesthesia operational performance. Anesthesia operational performance assessment of students was determined by quantifying critical event occurrences that negatively impacted patient safety during the anesthesia of 287 patients during students’ initial surgical experience in 2015 and 2016. The relationship between total numbers of critical incidents to students having anesthesia simulation training was determined through evaluation of anesthesia records from 2015 and 2016, where students did not have anesthesia simulation training or they had pre-clinical training, respectively. Results showed a significant relationship between simulation training and critical incident occurrence, with a critical incident more likely to occur during patient anesthesia for students who did not experience pre-clinical anesthesia simulation training. Of the total critical incidents that occurred in the two-year study, 88% were in patients anesthetized by students who did not have simulation training. Our findings suggest that students who were given the opportunity to participate in anesthesia-focused simulations before a live-animal anesthesia encounter demonstrated significant improvements in anesthesia operational performance and improved patient safety.

The ways through which we define fetuses and pregnant women has consequences in matters of abortion rights, in care following pregnancy loss and in the emotional experience of loss itself. Considering that maternal-fetal body, fetus status and maternal subjectivity are ontologically ambiguous, socially and technologically constructed and that they endure political tensions, this autoethnographic reflection on my cervical ectopic pregnancy focuses on how diverse medical-technological devices formed a semiotic and material field that modified my subjectivity making and unmaking a mother and transformed the status of personhood of my embryo from a quasi-child into a sort of cancer. By differentiating maternal status from maternal subjectivity, I also show how in western societies the maternal status of pregnant women is strictly linked to a pregnant body and to an existing and living fetus or embryo, but in the critical event of pregnancy loss, maternal subjectivity can follow other paths, paths that lack social recognition.

Because current automated vehicles have operational limitations, it is important to ensure that the fallback-ready driver is able to perform appropriately when required to take over control of the vehicle. However, time-related increase in driver drowsiness is well-known, and drowsy driving can affect response to take-over request (TOR). It was previously reported that a scheduled period of manual driving during automated driving was beneficial in maintaining driver arousal level. The present driving simulator study investigates the effects of scheduled manual driving on driver drowsiness and performance, as well as age differences therein. A total of 115 participants, whose gender was balanced and age was distributed uniformly from 20 to 70 years, drove an automated vehicle for 31 min, and a TOR was prompted before a collision event. A between-subjects design comprised two conditions: with versus without a scheduled 10-min interval of manual driving that ended 10 min before TOR. The Karolinska Sleepiness Scale and eyeblink durations estimated from electrooculograms (EOG) were used to subjectively and objectively measure participant’s drowsiness. Reaction time, standard deviation of steering wheel angle, and minimum Time-to-Collison (TTC) were extracted to measure driver performance in response to TOR. The alleviating effect on drowsiness of 10-min scheduled manual driving became non-significant after another 10-min period of automated driving. Although the scheduled manual driving had no significant effect for younger drivers, older drivers reacted significantly more slowly in both steering and braking at the critical event. These findings provide essential insights for human-vehicle interactions: Scheduled manual driving cannot maintain drivers’ arousal level for 10 min afterwards, and for older drivers, it would be better to avoid unnecessary task-switching between manual and automated driving.

Soil moisture is a key state variable in terrestrial water cycles, which links various land surface and hydrological processes. Owing to the significant spatiotemporal variability in soil moisture, collecting sufficient soil moisture data for relevant studies can be an astonishingly difficult task. Here, a statistical method based on the concept of depth functions was used to define Critical Events (CE) of soil moisture, which was hypothesized to contain disproportionally more system information on soil moisture dynamics. To test the feasibility of applying the CE concept for quantifying soil moisture dynamics, a long-term soil moisture dataset was retrieved from the Automated Weather Data Network (AWDN) located in the continental United States. The method of Temporal Stability Analysis (TSA) was adopted to examine the information embedded in soil moisture data that were collected under different conditions. The results showed that similar information on the relative as well as absolute wetness conditions at the AWDN sites was extracted from the entire time series and CEs of soil moisture, the latter of which contained much less soil moisture observations. Finally, the field data revealed that the occurrence of CEs of soil moisture in the study area was mainly affected by soil depth and interannual variability in precipitation. The number of CEs of soil moisture tended to be larger at deeper soil depths as well as in either dry or wet years than in normal years, suggesting that more soil moisture measurements under those conditions were needed to provide adequate information on soil moisture systems.

A cascade approach toward the tetracyclic core of akuammiline alkaloids which features high modularity and convergence is reported. Distinct substitution pattern can be readily introduced to the tetracyclic core by varying three building blocks with similar complexity. The critical event in the cascade is a regio- and stereoselective 1,2-shift enabled by a carbocation that sets up the core.

Stent infection after drug-eluting stent implantation is uncommon but is a critical event. In this study, we describe two such cases of coronary stent infection but with varied presentation. The first patient presented with recurrent stent thrombosis and acute coronary syndrome while the second patient was erroneously diagnosed as having tubercular pericarditis and was started on anti-tubercular therapy. Due to their possible fatal outcome, we herein report our experience with this uncommon clinical entity to help in rapid diagnosis and treatment. .

Ebola is examined as a Critical Event which shaped the communities in Bundibugyo district. The local framing of ebola epidemic 2007-8 as a curse to the particular ethnic groups affected the social networks and individual identities within communities. Ethnographic interviews and observations among victims of ebola were used as data, and a phenomenological approach was used to guide the research process. The paper recovers the lost moments and experiences of ebola survivors. The epidemic altered the socio-cultural set-up of the community and its impact have lasted for a long time; including stigma, discrimination, trauma, poverty and the orphan problem.Keywords: Ebola, Bundibugyo, Constructions, Critical Events

Natalia Walter, Internetowe wsparcie społeczne [Online social support]. Interdyscyplinarne Konteksty Pedagogiki Specjalnej, nr 23, Poznań 2018. Pp. 29-58. Adam Mickiewicz University Press. ISSN 2300-391X. DOI: https://doi.org/10.14746/ikps.2018.23.02 New media are the tools that support human’s intellectual functioning. For many people with disabilities they may become the sole opportunity for accessing information, communicating, learning or working. On the other hand, new media also provide a space for social interactions that could affect the process of coping with critical events, both ordinary and traumatic ones. The key concept for the discussion is internet-based social support, defined as support available online to a person dealing with a critical event which needs to be overcome with external resources coming from virtual groups comprising people experiencing difficulties of a similar nature, in the past or currently. The author posed the question whether internet social support is ubiquitous, and what it manifests itself. To answer this, she conducted quantitative and qualitative research. The data collected then became thebasis for analysis and theoretical considerations.

The growth in number of events, their attendance, and associated media coverage have contributed to a corresponding groundswell of interest in event studies (Baum, Lockstone-Binney, & Robertson, 2013). Since the mid-2000s, in part owing to Getz’s (2007) seminal work in the area, event studies have been widely explored in research, beginning with a plethora of management-related studies and pro-gressing beyond to conceptual and theoretical explo-rations (Lamond & Platt, 2016; Page & Connell, 2012; Thomas & Bowdin, 2012). The popularity of event studies is unsurprising given the ubiqui-tous nature of events, with the general populace exposed to a myriad of organized events, ranging from small-scale, private celebrations to highly commercialized sport mega-events. The ubiqui-tous nature of events is greatly helped by their ability to make use of existing infrastructure, supplemented by the use of temporary structures designed and built especially. Often, events make use of public space and infrastrucutre, which makes adequate and effective event management imperative to the local community’s acceptance of an event.

Traffic accidents, which cause loss of life and pollution, are a social concern. The complex traffic environment on mountain roads increases the harm caused by traffic accidents. This study aimed to identify safety-critical events related to accidents on mountain roads to understand the causes of the accidents, improve traffic safety, and protect the environment. In this study, a naturalistic-driving data collection system, consisting of approximately 8000 km of naturalistic-driving data from 20 drivers driving on mountain roads, was developed. Using these data, a comparative analysis of the identification performance of the support vector machine (SVM), backpropagation neural network (BPNN), and convolutional neural network (CNN) methods was conducted. The SVM was found to yield optimal performance. To improve the identification performance, the yaw rate and information entropy of the data were added as input variables. The improved SVM method yielded an identification accuracy of 90.64%, which was approximately 15% higher than that yielded by the traditional SVM. Moreover, the false positive and false negative rates of the improved SVM were reduced by approximately 10% and 20%, respectively, compared with the traditional SVM. The results demonstrated that the improved SVM method can identify safety-critical events on mountain roads accurately and efficiently.

The critical event in KRAS signaling and oncogenic transformation is activation of the RAF–MEK–MAPK cascade. This requires assembly of a multiprotein–lipid complex on the plasma membrane. In a tour de force of modeling, Mysore et al. now provide the first glimpse of what this structure may actually look like.

Critical event debriefing (CED) or ‘hot debriefings’ (HoDs) can be described as a trigger-based, immediate postevent, interprofessional, expertly facilitated conversation where clinicians recount, reflect on, and improve personally and as a team.1 The process and experience of clinicians who cared for the patient is more complex and involves thoughts and emotions that go beyond the ‘case’ or ‘resuscitation’ and the debriefing itself.2 The American Heart Association guidelines for neonatal resuscitation highlight ‘team debriefing’ as a key step in their cognitive aid.3 There is evidence that implementing a ‘Cold Debrief’ programme for teams that care for patients in cardiac arrest improves outcomes4 yet in practice 33% of events are routinely debriefed.5 Critical events in anaesthesia are debriefed infrequently and those associated with communication breakdowns were even less likely to be debriefed6. How do we fuel …

The oral explanation (OE) is a critical event during new marketing authorisation procedures in the European Union (EU). The primary objective of the present study was to investigate how many procedures, having an OE in front of the Committee for Medicinal Products for Human Use (CHMP), resulted in a regulatory approval for oncology products. Procedures for new marketing authorisation applications (MAAs) and Type II variations (new indication) for oncology products with at least one OE (with or without a Scientific Advisory Group (SAG) meeting) and for which the outcome took place between 31 January 2016 to 31 January 2020 were included in the analysis. Publicly available agendas/meeting minutes and assessment reports were used to obtain information on the products. An OE occurred in about 20% of procedures (n = 28/150) for oncology products during the review period. The majority of procedures having an OE (61%), with or without any SAG meeting, led to MAA/Type II variation approval in the Centralised Procedure. It was also observed that in 41% of the cases a successful outcome was contingent upon willingness of the applicant to restrict the indication. A majority of oncology procedures that had an OE resulted in a positive outcome suggesting that such agency interaction is an important opportunity for the applicant to have a last chance to resolve any outstanding issues at the final stage of the procedure.

International audience; Reliability-oriented sensitivity analysis methods have been developed for understanding the influence of model inputs relative to events which characterize the failure of a system (e.g., a threshold exceedance of the model output). In this field, the target sensitivity analysis focuses primarily on capturing the influence of the inputs on the occurrence of such a critical event. This paper proposes new target sensitivity indices, based on the Shapley values and called ``target Shapley effects'', allowing for interpretable sensitivity measures under dependent inputs. Two algorithms (one based on Monte Carlo sampling, and a given-data algorithm based on a nearest-neighbors procedure) are proposed for the estimation of these target Shapley effects based on the $\ell^2$ norm. Additionally, the behavior of these target Shapley effects are theoretically and empirically studied through various toy-cases. Finally, the application of these new indices in two real-world use-cases (a river flood model and a COVID-19 epidemiological model) is discussed.

In the management of IP networks, the collection and classification of notifications is a critical task. In addition to unexpected events, such as hardware and software failures, the collected notifications are important to make the proper diagnosis of the failure that occurred and based on that, propose and apply efficient solutions to the problems presented. This work develops a critical event manager using the “Ingenias” methodology for the analysis and design of the prototype. The developed software agent has the characteristic of being proactive, for which it permanently listens to notifications from a network of IP routers and interacting with it to mitigate problems and propose solutions to network failures.

The situation caused by the appearance of Covid-19 can be viewed as a critical event: typologically, it is an unprecedented event, which requires and shapes new forms of historical action hitherto unknown in the given context. Critical events serve as strong value and emotional landmarks in the cultural cognition of each social environment, and form the basis for a meaningful determination towards other events. Using material collected primarily from the online versions of electronic and printed media, we consider how the reality they presented is shaped through the news through the statements of politicians and medical doctors in Serbia. We trace how the narrative transformation of socio-cultural reality took place from the time before the of Covid-19 outbreak in our country to the time immediately after the lifting of the state of emergency declared due to that infection. The premise of all that is being done to tackle the infection is not a purpose in itself, but aims to enable a return to the life we were accustomed to before the outbreak of the epidemic. Covid-19 destabilizes our everyday life – a life that consists of work or study, use of free time, socializing etc. Such everyday life is a reference point of "normalcy". Socio-cultural normalcy refers to all that is understood as a normal and undisturbed course of everyday life. The appearance of Covid-19 gave rise to the notion of the "new normal", that is, a course of everyday life that is similar to normal, ordinary life, but with adherence to measures aimed at preventing the spread of infection by the authorities. In the paper we deal with the period that begins just before the outbreak of Covid-19 in our country, and ends with the period after the lifting of the state of emergency, to show the discursively produced picture of social reality in which the concept of the "new normal" serves as a cultural cognitive tool for understanding a situation in which one has to live with Covid-19 in order to one day be able to return to the way of life that existed before it.

Myocardial inflammation is a critical event for the onset and progression of the heart failure. Maresin 1 (MaR1) was originally identified as a macrophage lipid mediator that exhibits anti-inflammatory and pro-resolving activities. Though it is widely accepted that macrophages positively and negatively regulate myocardial inflammation through cytokines and growth factors, the biological functions of lipid mediators, such as MaR1, in cardiomyocytes remain to be addressed. This study explored the functional roles of MaR1 in cardiomyocytes. Neonatal rat cardiomyocytes (NRCMs) were stimulated with MaR1 for 48 hours. Immunofluorescent staining with anti-sarcomeric α-actinin antibody revealed that MaR1 (50 nM) induced a significant increase in cardiomyocyte surface area (1760.34±66.86μm 2 vs. 960.83±29.46μm 2 ). Quantitative RT-PCR analyses revealed that the treatment with MaR1 upregulated the expression of IGF-1 mRNA (2.9±0.6 folds), accompanied by the enhanced level of total and phosphorylated Akt. Interestingly, MaR1 did not influence the expression of BNP and skeletal actin significantly, suggesting that MaR1 induced physiological hypertrophy. Since MaR1 is a ligand of RORα, we examined the effects of RORα blockade (SR3335) and found that this compound inhibited the increase of cardiomyocyte surface area by abrogating MaR1-mediated activation of IGF-1/PI3K/Akt pathway. Importantly, treatment with wortmannin or NVP-AEW541, inhibitors for PI3K or IGF-1 receptor, respectively, suppressed MaR1-induced cardiomyocyte hypertrophy, indicating that IGF-1/PI3K/Akt pathway is essential for MaR1-induced hypertrophy. In conclusion, MaR1 is a novel lipid mediator that induces physiological cardiomyocyte hypertrophy by activating RORα/IGF-1/PI3K/Akt pathway. Thus, MaR1 could coordinate the resolving process and tissue recovery in myocardial inflammation.

The investigation of the carbon fibre reinforced plastic components under vibration fatigue testing is known to be challenging; as it involves the analyses of both the mechanical response and the inherent self-heating behaviour which emerges due to the high-frequency testing. The paper will firstly address an open question about the so-called critical event, which is a sudden change in one of the dynamic parameters measured during the fatigue test. Past experiments showed that such a change is associated with delamination, but its onset and early growth were not clarified. Therefore, a set of interrupted fatigue tests and CT scan measurements will show the onset of delaminations and how these are correlated with the vibration parameters. The second objective is to investigate the failure behaviour under vibration fatigue and elevated environmental temperatures. The research will present both the experimental set-up for achieving fatigue under environmental conditions and the vibration data obtained from testing samples at many severity levels; both in terms of applied mechanical vibrations and thermal loads. The paper will investigate how the inherent self-heating behaviour and the applied thermal load will affect the time to failure of composites. The relationship between fatigue behaviour and environmental temperature conditions are presented in two forms. The first one is a typical S-N curve, whereas the second one, the relationship between the response phase and hot-spot temperature data. Both relationships will show how relevant is the environmental temperature in terms of fatigue behaviour for the type of components presented in this paper.

Recent findings indicate that both disruptive Post-Traumatic Stress Disorder (PTSD) and healthy Post-Traumatic Growth (PTG) responses have some spatial distribution depending on where they are measured and the different degrees of exposure that people may have to a critical event (e.g., earthquake). Less is known about how these responses change as a function of space and time after these events. The objective of this study was to enter deeper into this relationship analysing how PTSD and PTG responses vary in their spatial distribution 6 and 7 years after an earthquake (such as the one that occurred on 27 February, 2010 in Cauquenes City, Chile). Spatial analyses based on Geographic Information Systems (GIS) were performed to detect global and local geographic clustering. Investigating 171 (2016) and 106 (2017) randomly selected adults from Cauquenes, we demonstrated that 7 years after the event only 4 variables were spatially clustered, i.e. personal mental strength, interpersonal relations, new possibilities and appreciation of life), all of them PTG dimensions; This result contrasted with the situation the previous year (2016), when 7 variables were clustered (total PTG, spiritual change, new possibilities, appreciation of life, PTSD symptoms, PTSD reactions and PTSD in total). The spatial identifications found could facilitate the comparison of mental health conditions in populations and the impact of recovery programmes in communities exposed to disasters.

Many factors come together probabilistically to affect clinician response to critical events in the operating room; no 2 critical events are alike. These factors involve 4 primary domains: (1) the event itself, (2) the individual anesthetist(s), (3) the operating room team, and (4) the resources available and environments in which the event occurs. Appreciating these factors, anticipating how they create vulnerabilities for error and poor response, and actively addressing those vulnerabilities (before events occur as well as during) will help clinicians manage critical event response more effectively and avoid errors.

BACKGROUND: Firefighters partake in and are exposed to a range of potentially traumatic events throughout their careers and the impact of such critical events could last a life time. Therefore, capturing such lifetime exposures is necessary for supporting firefighter health. OBJECTIVE: To estimate the prevalence of critical incidents in firefighters across Canada and determine whether the number of critical events varied based on age, gender, years of service; and to integrate our prevalence estimates using meta-analysis with previous studies to provide a pooled estimate. METHODS: We recruited 464 firefighters. Firefighters were asked to complete a self-report Critical Incident Inventory (CII) survey that included questions on exposure to critical events throughout their firefighting careers. Individual CII items were summarized as percentages, number of exposures, the total number and percentages of exposures to each of the six CII sub-scales. We also performed a multivariate enter regression analysis with the CII total score as dependant variable, and age, gender, years of service as independent variables, to estimate if the number of critical incidents among firefighters varied based on age, gender and years of service. RESULTS: Among the 390 full-time firefighters, 376 (96.4%) indicated exposure to some type of critical incident. More specifically, 351 (90%) reported a “respond to incident involving one or two deaths”, and 314 (81%) reported a “respond to incident involving multiple serious injuries”. Age, gender and years of service accounted for only 37.4% of the variance in the number of critical incidents among firefighters. In addition, our pooled estimate results of previous similar studies indicated an overall prevalence estimate of critical incident exposures was 93.40% (4 studies, 1725 of 1877 firefighters, 95% CI: 82.26 –99.30). CONCLUSIONS: Nearly all (96.4%) firefighters were exposed to some form of critical event over the span of their entire firefighting careers. Age, gender and years of service accounted for one-third of the variance in the number of critical incident exposures among firefighters.

The perioperative care of infants and children demands special training and facilities due to possible critical events. The APRICOT study (Anaesthesia PRactice In Children Obervational Trial) analyses more than 30.000 anaesthetic procedures from 33 different European countries. Through a detailed prospective observational cohort study, this trial identifies the incidence, the nature and the outcomes of severe critical events in children, including laryngospasm, bronchospasm, cardiovascular instability and cardiac arrest, neurological damage, anaphylaxis or drug errors. Some reported results differ from what was previously published in the literature. Large variation of the collected data allows to identify those risk factors contributing to the severe critical events, among them, the anaesthetist and the centre. This study especially motivates to create clinical practice guidelines of paediatric anaesthesia management for a safer Anaesthesia., El manejo anestésico del paciente pediátrico requiere de una formación y unas estructuras específicas, debido a las situaciones adversas que se pueden producir. El estudio APRICOT (Anaesthesia PRactice In Children Obervational Trial) con una muestra de más de 30.000 pacientes de 33 países europeos y a través de un minucioso análisis observacional de cohortes prospectivo, recoge la naturaleza, la incidencia y los factores de riesgo de los evento críticos más comprometedores; desde los más comunes como el laringoespasmo o el broncoespasmo, la bradicardia hasta la parada cardiaca, pasando por fenómenos neurológicos, anafilaxia o errores de medicación. Obtiene unos resultados que distan en algunos aspectos de lo estudiado hasta ahora. La diversidad de los datos analizados permite identificar aquellos factores de riesgo relacionados con los eventos críticos, entre ellos el anestesista y el centro hospitalario. Pero sobre todo da pie a la necesidad de crear guías de manejo anestésico pediátrico encaminadas hacia una Anestesia más segura.

Summary Background Reversion of an implantable cardioverter defibrillator (ICD) to back-up mode degrades the operating capabilities of the device, puts patients at risk and requires rapid intervention by a manufacturer's technician. Aim To illustrate the usefulness of remote monitoring of ICDs for the early detection of reversion to back-up mode. Methods In our centre, all patients implanted with an ICD, with or without resynchronisation, were offered remote monitoring as soon as the technology became available. Alerts triggered by the remote monitoring system were included prospectively in a register. During a mean follow-up of 5.7 ± 1.3 years, a total of 1594 patients with an ICD (441 with resynchronisation function) followed with remote monitoring were included in the register. Results Among 15,874 alerts, only 10 were related to a reversion to back-up mode. Among those, seven reversions were caused by radiotherapy, two were fake events and one was caused by magnetic resonance imaging. Except for the two fake events, the eight other patients had an emergency admission for the resetting and reprogramming of their ICD. None of the reversion to back-up mode alerts was followed by a clinical alert (i.e. a shock alert) before the ICD problem was resolved. Conclusions Reversion to back-up mode is a very rare event, accounting for 0.06% of total alerts; remote monitoring facilitates the early detection of this critical event to resolve the problem faster than the next scheduled follow-up. Remote monitoring can prevent serious damage to the patient and avoids systematic ambulatory control of the ICD after each radiotherapy session.